Does pre-operative traction on the cervix approximate intra-operative uterine prolapse? A randomised controlled trial

Chao, Fay; Rosamilia, Anna; Dwyer, Peter; Polyakov, Alex; Schierlitz, Lore; Agnew, Gerard

doi:10.1007/s00192-011-1656-0

Cited by 15 publications

(4 citation statements)

References 17 publications

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“…The greatest differences between measurements were observed for points C and D, both representing the apical compartment. This is consistent with data reported previously for point C . The present findings are also in agreement with other studies; but the prolapse observed on traction for all intravaginal POP‐Q points was greater in the present study than in previous investigations.…”

Section: Discussionsupporting

confidence: 94%

“…However, it has been observed that the stage of POP detected is greater in an upright position than in a lithotomy position for many women, even with maximum straining . Furthermore, previous research has suggested that there is a significant difference between POP‐Q measurements made in clinic with the Valsalva maneuver and those made under general anesthesia in theater with applied traction . However, this study reported limited data in terms of different POP‐Q points.…”

Section: Introductionmentioning

confidence: 75%

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Comparison between the Valsalva maneuver and intraoperative traction measurements in pelvic organ prolapse assessment

Doumouchtsis

Gauthaman

Khunda

et al. 2017

Intl J Gynecology & Obste

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Measurements of six POP-Q points obtained with traction showed a higher grade of POP than those assessed with Valsalva maneuver. On this basis, surgeons might decide on the extent of surgical procedure after examination under anesthesia; however, preoperative patient counselling would be essential to obtain consent for this approach. The clinical significance of the findings requires further evaluation.

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Section: Discussionsupporting

confidence: 94%

Section: Introductionmentioning

confidence: 75%

Comparison between the Valsalva maneuver and intraoperative traction measurements in pelvic organ prolapse assessment

Doumouchtsis

Gauthaman

Khunda

et al. 2017

Intl J Gynecology & Obste

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“…Chao et al compared preoperative point C without traction to intraoperative point C with traction [6] and found a mean difference of ∼3.5 cm and a 3 cm or greater difference in 57%. Both studies confirm that there is a significant difference in cervical descent between the preoperative and intraoperative exam.…”

Section: Discussionmentioning

confidence: 99%

Apical Descent in the Office and the Operating Room

Crosby

Sharp²,

Gasperut

et al. 2013

Female Pelvic Medicine &Amp; Reconstructive Surgery

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Objectives The support of the uterine cervix assessed in the clinic with Valsalva or cough and operating room (OR) with traction often differs. The objective of this study is to test the null hypothesis that the difference between preoperative and intraoperative values of POP-Q (Pelvic Organ Prolapse Quantification) point C is not related to prolapse size, and to determine if other factors exist that predict this difference. Methods This is a retrospective review of women who had a vaginal hysterectomy in the FPMRS (Female Pelvic Medicine and Reconstructive Surgery) division between 2005 and 2011 and had preoperative and intraoperative POP-Q point C recorded. A difference of 5 cm was established by a panel of urogynecologists as clinically significant. Student t-tests and chi-squared analyses were used and a logistic regression performed. Results There were 206 subjects included. The mean difference in point C between the two clinical settings was 3.5 cm. A difference of ≥5 cm was present in 33%. The mean difference in point C was larger for women with lesser stages of prolapse (stage 1: 5.8 cm, stage 2: 3.0 cm, stage 3/4: 1.4 cm, p<.001). A difference of ≥5 cm in point C was more often present in women with lesser stages of prolapse–70.3% of women with stage 1, 9.3% for stage 2 and 8.5% for stage 3 (p<0.001). Conclusions We reject our null hypothesis. A difference of ≥5 cm between POP-Q point C in the clinic and the operating room occurred more frequently in women with lesser stages of prolapse.

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“…11 In a recent study, a difference in uterine descent between traction with the patient awake and under anesthesia was recorded as 1.6 cm. 15 However, traction force was not standardized so the degree to which clinicians pulled harder on anesthetized patients compared to those who were awake is unknown. Even taking these factors into account it seems likely that the biomechanical measurements (including stiffness) obtained during the OR tests possibly lie outside the physiological range; that is, the position of the uterus during a woman’s normal activities, including Valsalva, get to the point where the stiffness of the ligaments is challenged only in a minority of women (Figure 4c).…”

Section: Commentmentioning

confidence: 99%

A novel technique to measure in vivo uterine suspensory ligament stiffness

Smith

Luo

Hsu

et al. 2013

American Journal of Obstetrics and Gynecology

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Objective To describe a new computer-controlled research apparatus for measuring in vivo uterine ligament force-displacement behavior and stiffness and to present pilot data in women with and without prolapse. Study Design Seventeen women with varying uterine support underwent testing in the operating room (OR) after anesthetic induction. A tripod-mounted computer-controlled linear servoactuator was used to quantify force-displacement behavior of the cervix and supporting ligaments. The servoactuator applied a caudally-directed force to a tenaculum at 4 mm/s velocity until the traction force reached 17.8N (4 lbs.). Cervix location on POP-Q in clinic, in the OR at rest, and with minimal force (<1.1N), and maximum force (17.8N) was recorded. Ligament “stiffness” between minimum and maximum force was calculated. Results The mean (SD) subject age was 54.5 (12.7) years, parity 2.9 (1.1), BMI 29.0 (4.3) kg/m2, and POP-Q point C −3.1 (3.9) cm. POP-Q point C was most strongly correlated with cervix location at maximum force (r=+0.68, p=.003) and at rest (r=+0.62, p=.009). Associations between cervix location at minimum force (r=+0.46, p=.059) and ligament stiffness (r= −0.44,p=.079) were not statistically significant. Cervix location in the OR with minimal traction lay below the lowest point found on POP-Q for 13 women. Conclusions POP-Q point C was strongly correlated with cervix location at rest and at maximum traction force; however only 19% of the variation in POP-Q point C location was explained by ligament stiffness. The cervix location in the OR at minimal traction lay below POP-Q point C value in ¾ of women.

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Does pre-operative traction on the cervix approximate intra-operative uterine prolapse? A randomised controlled trial

Cited by 15 publications

References 17 publications

Comparison between the Valsalva maneuver and intraoperative traction measurements in pelvic organ prolapse assessment

Comparison between the Valsalva maneuver and intraoperative traction measurements in pelvic organ prolapse assessment

Apical Descent in the Office and the Operating Room

A novel technique to measure in vivo uterine suspensory ligament stiffness

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